一九二四年，我回乡行医。当时，乡问农民生活极为贫困，积劳成疾，故病多危重，尤多热病重症，如霍乱吐泻，高热痉厥逆等等，病情凶险复杂，倏忽多变。面对耩手之症，我在钻研叶天士《温热论》、吴鞠通《温病条辨》的基础上，又勤读雷少逸《时病论劳、吴叉可《温疫论》、戴天章《广温疫论》等医籍，掌握了一般温病与时行疫毒的治疗差异，啉会到但持桑菊、银翘辈轻清之剂，常无显效，而投以治疗秽浊戾气的方药，使疗效有了提高。然而，我又深感温病诸书，虽对保津开窍之法颇多发挥，但对厥逆之变的辨治，尚有不足之处。如当时霍乱流行，病死者甚多，其症见卒然暴吐泻，手足蹶冷，汗出，大渴引饮，得饮即吐。一般医家从温病之法，投甘寒或苦寒清热之剂，活人者鲜。而我据仲景所论，投白通加猪胆汁汤，获效者不少。从中得到启发，必须进一步深研《伤寒论》，以补温病之不足，并借鉴《伤寒指掌》一书，探索融会六经及卫气营血辨证，以为救治热病重证的方法。古人说，对待伤寒与温病，须纵横看，我觉得此语甚妙。纵横交织，本一体也。无可否认，就两者方药论，各有偏重专长，只有融会贯通，方能左右逢源于临床。
例如：方××，男，25岁，某院会诊病例。病者原总有肾病综合征，住××医院内科病房，使用西药塞嘴派。在第十七次治疗后，白细胞突然下降至200／立方毫米，并伴高热，体温40．5。c，两次血培养均有金黄色葡萄球菌生长，西医诊断为败血症，继发性再生障碍性贫血，立即停用塞瞄派，并用多种抗菌素静脉滴注及肌肉注射五天，高热不退，证情凶险。一九八0年十月二十五日我应邀往诊，证见高热六天不退，入夜口渴，便秘，两下肢红斑(出血点)，苔黄腻柑厚中裂而干，脉象虚细而数。我分析，病系正气大亏，客邪乘虚而入，邪热亢盛，炽于气分，灼伤阴津，且见入营之势。治应扶持正气，清化邪热，投人参白虎汤，参以凉血救治之。方用生晒参、铁皮石斛益气保津，石膏、知母、银花、连翘清热透泄，赤芍、丹皮、旱莲、泽兰取其凉血散血之意，以杜传变。全方「清」、「透」、「养」三法同用，服药二剂，高热得平，白细胞上升至4900／立方毫米。病房医师以此方为清热妙剂，敞又嘱患者续服原方三剂。至十月三十日再邀会诊，病者出现嗜睡懒言，面色萎黄，汗出较多，口渴聃痛，苔根腻，舌淡红中裂，脉细数，重按无力等症。我考虑此由邪伤气阴，又过服寒凉清热之剂，以致阳气伤损，有虚阳外越之兆，邪热虽化未彻，而有内传少明之虞。故治疗重在扶养正气，佐彻余邪。方中重用吉林白参、黄芪、当归补气血以托邪，牡蛎、白芍和营卫以歙汗，柴胡、银花、连翘以透余邪，佐入麦冬清热养阴。服四剂后，热病告愈，二周后复查，二次血培养未见细菌生长。
本案治疗，我先宗温病，后法伤寒，不拘一格，努力做到立法用药，知微杜渐，防变于未然，这样才掌握了主动权。
谙熟医理治贵达变
我自农村副市区行医后，临诊时内、妇杂病渐渐增多，间遇达官大贾，治病遣方须小心谨慎。在诊病之余，我深入研读东垣、丹溪、景岳等名家医论及联名医类案》、《柳选四家医案》、《临证指南医案》，并常置《类证治裁》于案头，随时翻阅。且到沪以后，也常有机会与老同学程门雪、秦伯未等互相切磋。经过二十余年的学验结合，视野遂广，意境渐上。一九五六年我参加曙光医院工作，病种接触面更为广泛，并担任了高等中医教育的内科临床教学任务，从而迫使我把所掌握的中医理论系统化，条理化。然而，我总感到自己的经验比较局限，临床疾病又千变万化，不胜尽治，因思古人「天下无不可治之疾，有不可治之医」的告诫，认识到关键是在医者必须熟读经典，旁通诸家，又善守常达变，付诸临床。这正是医道的至要所在。例如樊××，女，46岁o1974年9月21月初诊：患者由车撞致脑外伤昏迷，经某医院治疗二十四天，仍神志昏迷。右手有无意识动作，左手及两下肢不能活动，脉弦数，舌苔干喊。头脑受伤，血瘀阻络，拟醒脑活血通络，投通窍活|汤原方加菖蒲、郁金、至宝丹。
二诊；神志时清时昧，头痛烦躁狂叫，日夜不休，便秘腹痛，舌苔转淡黄腻，脉弦小数。骤受撞伤，瘀热凝阻，有如《伤寒论》蓄血如狂之症，与阳明热盛发狂不同，拟抵当汤加味，化瘀清神。方用水蛭、虻虫各9克，桃仁12克，当归18克，山栀15克，红花9克，生川军6克(后入)，鲜石首蒲16克，郁金、茯苓各9克。
三诊：前投抵当重剂加味，服至第四剂时，左手及两下肢已能活动}故七剂后叉服十剂，烦躁狂叫大为减轻，神识渐清，但不能言语，昨日便软三次，腹痛已止，舌苔黄腻，脉弦小。脉络血瘀渐化，惟痰湿热尚阻中焦，再拟活血和中而化湿热。黄连温胆汤合通窍活血汤(去麝香)加菖蒲、蔻仁。
此后，烦躁惊叫除，神志渐清，但时有幻觉，据证予活血清神、和中舒胃以及调补气阴，佐吼清化之剂治疗，症除病愈。先后共调治五十余天。
《伤寒论》蓄血膀胱是指太阳府证，瘀热在里，可见「如狂」一证。而与本例发狂，虽病变部位不一，然病机雷同，皆瘀热犯于神明所致。且抵当汤方用水蛭、虻虫，峻猛破瘀逐血，又合桃仁、大黄破血荡热，导瘀下行，颇合本病治则，故我广其意而用于本饲治疗，收列了满意的疗效。
又如，《伤寒论》中的桂枝汤，其适应症何尝仅止于太阳病中风证。按其组方，当有和营温经，振奋脾胃，缓急止痛诸作用。因此，我把它广泛地应用于慢性泄泻、慢性胰腺炎、胃痛、虚劳以及神衰等属虚寒证者，效果息好，这是桂枝汤的达变于临床。
由上而知，学习《伤寒论》、《金匮要略》等原著，须重视其辨证之细致、用药之精当，从中寻绎其旨意，再据「但见一证便是，不必悉具，知犯何逆，随证治之」的精神，于临床中灵活应用。当然，在对待其它医家著作上，也同样如此。
不囿成说抒发己见
我常对学生说：「精通医学以熟诲医理为首务。但是，欲求发展，又不可因循沿袭，为成说所囿，不敢越雷池一步。须结合临床，深入体察，勤于思考，善于总结，以得真知，抒发己见。」近三十年来，我也是这样要求自己，以求得学术上的进步的。
如对肝脏阴阳的认识，古人谓肝脏体阴而用阳，肝阴肝血其体可虚，而肝气肝阳其用总属太过。在数十年临诊过程中，我常思索这一问题：五脏皆有阴阳，均可见有阴阳之虚，何惟独肝气肝阳之无虚?f此说片面可知。纵然，吴澄、唐容川等医家曾提及肝气虚、肝阳虚，但乏于阐述，未能付诸临床。其实，l瞄床中肝气虚、肝阳虚何尝少见，在肝炎、肝硬化病例中尤属多见，其症如胁肋隐痛，或胀痛绵绵，劳累则增剧，神疲乏力，腹胀纳果，面色灰滞萎黄，悒悒不乐，其或艮寒肢冷，舌多淡红胖，苔自或腻，脉虚细弦或沉细无力，并常与脾气弱、脾阳虚同见，治疗当以益气温阳、补肝建脾为原则，用参、苠、附于、白朮、茯苓、细辛、白芍、枣仁、乌梅、木瓜之类。对此类病人，如执持成说，反用疏肝泄肝，投以大量理气活血之品，必致戕伐太过，更虚其虚。兹举我用附子、白朮合桂枝汤温振肝脾阳气治疗早期肝硬化的案例如下：
王××，女，49岁。
1974年儿月5口初诊：患者罹早期肝硬化，近年来肝区胀痛，神倦纳果，面色灰黄，月经二月术转，畏寒肢冷，盗汗，脉沉细无力，苔白滑。肝气虚，脾阳弱，气血不足。拟温阳而补气血，猷观动静：
熟附子、炒白芍各g克，鸡咀藤15克，白朮9克，炙甘草、青陈皮各4．5克，桂枝6克，当归12克。
二诊：肝区胀痛得减，畏寒肢冷依然，经停已转，寐则多汗，面色萎黄，神疲纳增，脉细、苔白润。方药合度，仍守前法，以冀进步。
服上方后，症情又见好转，再守方参入枣仁、牡蛎、党参、川芎等药，连服二月，肝区胀痛得除，形寒肢冷转温，面有华色，艰寐盗汗亦瘥。蛋白电泳的r球蛋白从12．5％上升至15．5％，血沉降率从35～65毫米／小时下降至正常范围，并恢复工作。随访年余，证情稳定，未见反复。
又如急性心肌梗塞，很多学者认为属中医「真心痛」的范畴。据临床体验，对照《金匮》及有关医着的记载，我认为本病不仅属于「真心痛』，还应属于「胸痹」范畴。大致可作如下划分：右胸疼痛剧烈，或者手足青至节，并在二十四小时内死亡的，为「真心痛」，痛虽剧烈，但不迅速死亡的为「胸痹」。《金匮》论「胸痹」日；「阳微阴弦」，乃指心胸阳虚，阴寒痰饮乘于阳位所致，故治疗也局限于补阳益气、通阳散结、豁痰化饮之剂。近十多年来，据我临床所见，《金匮》所论与实际不尽相台。就本病病机而言，本虚标实确是心肌梗塞的特点所在。但本虚非徒阳虚，尚可见气虚、阴虚、阴阳两虚，甚或阳微阴竭，心阳外越等；标实也非仅痰饮为患，尚有气滞、血瘀致害，。又有兼寒兼热之不同。同时，标本之间多相互影响，未可执一而言。因此，在治疗上也不能拘泥于《金匮》，应随证遣方，灵活掌握。我根据本病发生发展的规律，总结了三个治疗要点；一是处理好「补」和「通」的关系，掌握好「祛实通脉不伤正，扶正补虚不碍邪」的原则；二是防脱防厥，要细致观察患者在神、气息、汗、疼痛、四末及素体温度、舌苔、脉象等方面的变化，随时警惕厥脱的发生，用药也宜于厥脱之先，三是关于通便问题。本墒患者常见便秘一证，由大便不畅引起心跳骤停而死亡者并不少见，故及时而恰当地通便，为治疗心肌梗塞的重要方法。立法用药时应分清阳结阴结，采取「先通使去实，然后扶正补虚』或「补虚为主，辅以通便」等法，以助正气的恢复(详见《上海中医杂志》一九八一年第十期)。
类似上述的例子，在临床中比比皆是，不胜枚举。我觉得，面对临床实际，敢于提出新说，以发展祖国医学，这是我们义不容辞的责任。
在我年轻的时候，曾读《千金要方》，难解其意，视为「偏书」。解放初期我曾见方行维老先生治病用药甚为夹杂，每每认为是无师传授的结果。近二十余年来，我所遇疑难杂症，与日俱增，投以平时熟用之法，取效者不多，常百思不解。在这种情况下，遂再次攻读《千金要方》。随着阅历的加深，读起来就别有一番感受。我感到该书医学理论纵然不多，而方症记录朴实可信，其表里、寒热、补泻，升降、通涩等药常融冶在一方之中，可谓用心良苦，奥理蕴在其中。所谓疑难杂症者，大多症情错杂，非一法一方所能应对，当须详细辨证，切中病机所在，方能奏效，而不能被某些狭隘的理论所束缚，更不能受流派所承的学验所限制，必须扩展视野，进一步研究《千金》组方之杂，观察其临床之验，我想这是探索治疗疑难杂症的重要途径之一。例如：
1975年11月15日初诊：素有痰饮，近加外感，咳嗽气急口渴，自觉内热，高年心气不足，四末欠温，水湿赫留于下，二足浮肿，脉小数促，苔薄白腻。正虚邪实，寒热夹杂。拟标本兼治，益心肾而清化痰热：、净麻黄4．5克，杏仁g克，生石膏24克，泽泻18克，炙甘草3克，党参、熟附片各9克，开金锁(另蒸冲服)、鱼腥革各30克，防己12克。
二诊；咳嗽减轻，气急渐平，咯痰亦少，胸闷不痛，心悸且慌，四肢渐温，脉细数促不匀，舌质暗。
太阴痰热日见清化，心肾亏损亦得好转，再拟养心活血佐以化湿肃肺：
熟附片15克，党参12克，炙甘草6克，泽泻，当归各15克，麦冬9克，炒川连2．4克，丹参15克，红花6克，防己12克。
本例素体肺气虚，痰饮内停，久而及于心肾，，复又感受外邪，引动宿疾，遂致咳喘脉促，饮溢经络。患者又有口渴、内热、四肢欠温等症，寒热错杂之象，必探其本而标本兼治之。未可一味治标，故以麻杏石甘汤合参附汤，寒热并用，扶正祛邪，仅服七剂,证情大减，继以温阳养心肃肺活血之剂而收功。此乃宗《千金方》寒热补泻相兼组方之意，结合具体病症加以运用，从而使本例重病得到缓解，如：
1973年2月28日初诊；患者于解放战争时期有脑震荡史。从一九六0年起常有嗜睡或不眠之象，证情逐年加重。近四、五年来，嗜睡与不眠交替而作，眠则三、四十天日夜不醒，饮食须由家属呼而喂之，边食边睡，二便亦须有人照顾，有时则自遗；醒则十数天日夜不眠，烦躁喜动，头晕且胀。平时腰酸怕冷，手足逆冷，面色晦暗。得病之后，曾赴各地迭治不效，遂来沪诊治。刻下，神倦呆钝，边诊边睡，家属诉纳食尚可，口干，便艰解燥屎，苔白腻，舌边紫暗，脉沉细濡。多年顽疾，寒热虚实错综复杂，恐难骤效。书云「怪病属痰」。痰浊蒙蔽心窍，神志被困。姑先拟清心涤痰镇静宁神法，以观动静；
1924年，我回到家乡行医。当时，乡间农民生活极其贫困，因长期劳累而致病，所以疾病大多危重，尤其是热病重症很多，如霍乱引起的呕吐腹泻、高热导致抽搐昏迷等，病情凶险复杂，变化迅速。面对这些棘手病症，我在钻研叶天士《温热论》、吴鞠通《温病条辨》的基础上，又勤奋阅读雷少逸《时病论》、吴又可《温疫论》、戴天章《广温疫论》等医学典籍，掌握了一般温病与时行疫毒在治疗上的差异，体会到仅使用桑菊饮、银翘散等轻清之剂，常常没有明显疗效，而投用治疗秽浊戾气的方药，则使疗效有了提高。然而，我又深感温病各类书籍，虽然对保津开窍之法有很多发挥，但对于厥逆变化的辨证治疗，还有不足之处。如当时霍乱流行，死亡者甚多，其症状表现为突然剧烈呕吐腹泻，手足厥冷，出汗，极度口渴想喝水，但喝下去就吐出来。一般医生按照温病的方法，投用甘寒或苦寒清热之剂，救活的人很少。而我根据张仲景的论述，投用白通加猪胆汁汤，获效者不少。从中得到启发，必须进一步深入研究《伤寒论》，以弥补温病的不足，并借鉴《伤寒指掌》一书，探索融会六经辨证及卫气营血辨证，作为救治热病重证的方法。古人说，对待伤寒与温病，须纵横看，我觉得此语甚妙。纵横交织，本为一体也。无可否认，就两者方药论，各有偏重专长，只有融会贯通，方能左右逢源于临床。
例如：方某，男，25岁，某院会诊病例。患者原有肾病综合征，住在某医院内科病房，使用西药塞米松。在第十七次治疗后，白细胞突然下降至200／立方毫米，并伴高热，体温40.5℃，两次血培养均有金黄色葡萄球菌生长，西医诊断为败血症，继发性再生障碍性贫血，立即停用塞米松，并用多种抗菌素静脉滴注及肌肉注射五天，高热不退，证情凶险。一九八0年十月二十五日我应邀往诊，证见高热六天不退，入夜口渴，便秘，两下肢红斑(出血点)，苔黄腻垢厚中裂而干，脉象虚细而数。我分析，病系正气大亏，客邪乘虚而入，邪热亢盛，炽于气分，灼伤阴津，且见入营之势。治应扶持正气，清化邪热，投人参白虎汤，参以凉血救治之。方用生晒参、铁皮石斛益气保津，石膏、知母、银花、连翘清热透泄，赤芍、丹皮、旱莲、泽兰取其凉血散血之意，以杜传变。全方「清」、「透」、「养」三法同用，服药二剂，高热得平，白细胞上升至4900／立方毫米。病房医师以此方为清热妙剂，故又嘱患者续服原方三剂。至十月三十日再邀会诊，病者出现嗜睡懒言，面色萎黄，汗出较多，口渴咽痛，苔根腻，舌淡红中裂，脉细数，重按无力等症。我考虑此由邪伤气阴，又过服寒凉清热之剂，以致阳气伤损，有虚阳外越之兆，邪热虽化未彻，而有内传少阴之虞。故治疗重在扶养正气，佐彻余邪。方中重用吉林白参、黄芪、当归补气血以托邪，牡蛎、白芍和营卫以敛汗，柴胡、银花、连翘以透余邪，佐入麦冬清热养阴。服四剂后，热病告愈，二周后复查，二次血培养未见细菌生长。
本案治疗，我先宗温病，后法伤寒，不拘一格，努力做到立法用药，知微杜渐，防变于未然，这样才掌握了主动权。
谙熟医理治贵达变
我自农村副市区行医后，临诊时内、妇杂病渐渐增多，间遇达官大贾，治病遣方须小心谨慎。在诊病之余，我深入研读东垣、丹溪、景岳等名家医论及《名医类案》、《柳选四家医案》、《临证指南医案》，并常置《类证治裁》于案头，随时翻阅。且到沪以后，也常有机会与老同学程门雪、秦伯未等互相切磋。经过二十余年的学验结合，视野遂广，意境渐上。一九五六年我参加曙光医院工作，病种接触面更为广泛，并担任了高等中医教育的内科临床教学任务，从而迫使我把所掌握的中医理论系统化，条理化。然而，我总感到自己的经验比较局限，临床疾病又千变万化，不胜尽治，因思古人「天下无不可治之疾，有不可治之医」的告诫，认识到关键是在医者必须熟读经典，旁通诸家，又善守常达变，付诸临床。这正是医道的至要所在。例如樊某，女，46岁，1974年9月21日初诊：患者由车撞致脑外伤昏迷，经某医院治疗二十四天，仍神志昏迷。右手有无意识动作，左手及两下肢不能活动，脉弦数，舌苔干燥。头脑受伤，血瘀阻络，拟醒脑活血通络，投通窍活血汤原方加菖蒲、郁金、至宝丹。
二诊：神志时清时昧，头痛烦躁狂叫，日夜不休，便秘腹痛，舌苔转淡黄腻，脉弦小数。骤受撞伤，瘀热凝阻，有如《伤寒论》蓄血如狂之症，与阳明热盛发狂不同，拟抵当汤加味，化瘀清神。方用水蛭、虻虫各9克，桃仁12克，当归18克，山栀15克，红花9克，生川军6克(后入)，鲜石菖蒲16克，郁金、茯苓各9克。
三诊：前投抵当重剂加味，服至第四剂时，左手及两下肢已能活动；故七剂后又服十剂，烦躁狂叫大为减轻，神识渐清，但不能言语，昨日便软三次，腹痛已止，舌苔黄腻，脉弦小。脉络血瘀渐化，惟痰湿热尚阻中焦，再拟活血和中而化湿热。黄连温胆汤合通窍活血汤(去麝香)加菖蒲、蔻仁。
此后，烦躁惊叫除，神志渐清，但时有幻觉，据证予活血清神、和中舒胃以及调补气阴，佐以清化之剂治疗，症除病愈。先后共调治五十余天。
《伤寒论》蓄血膀胱是指太阳腑证，瘀热在里，可见「如狂」一证。而与本例发狂，虽病变部位不一，然病机雷同，皆瘀热犯于神明所致。且抵当汤方用水蛭、虻虫，峻猛破瘀逐血，又合桃仁、大黄破血荡热，导瘀下行，颇合本病治则，故我广其意而用于本例治疗，收到了满意的疗效。
又如，《伤寒论》中的桂枝汤，其适应症何尝仅止于太阳病中风证。按其组方，当有和营温经，振奋脾胃，缓急止痛诸作用。因此，我把它广泛地应用于慢性泄泻、慢性胰腺炎、胃痛、虚劳以及神衰等属虚寒证者，效果极好，这是桂枝汤的达变于临床。
由上而知，学习《伤寒论》、《金匮要略》等原著，须重视其辨证之细致、用药之精当，从中寻绎其旨意，再据「但见一证便是，不必悉具，知犯何逆，随证治之」的精神，于临床中灵活应用。当然，在对待其它医家著作上，也同样如此。
不囿成说抒发己见
我常对学生说：「精通医学以熟谙医理为首务。但是，欲求发展，又不可因循沿袭，为成说所囿，不敢越雷池一步。须结合临床，深入体察，勤于思考，善于总结，以得真知，抒发己见。」近三十年来，我也是这样要求自己，以求得学术上的进步的。
如对肝脏阴阳的认识，古人谓肝脏体阴而用阳，肝阴肝血其体可虚，而肝气肝阳其用总属太过。在数十年临诊过程中，我常思索这一问题：五脏皆有阴阳，均可见有阴阳之虚，何惟独肝气肝阳之无虚？此说片面可知。纵然，吴澄、唐容川等医家曾提及肝气虚、肝阳虚，但乏于阐述，未能付诸临床。其实，临床中肝气虚、肝阳虚何尝少见，在肝炎、肝硬化病例中尤属多见，其症如胁肋隐痛，或胀痛绵绵，劳累则增剧，神疲乏力，腹胀纳呆，面色灰滞萎黄，悒悒不乐，其或畏寒肢冷，舌多淡红胖，苔白或腻，脉虚细弦或沉细无力，并常与脾气弱、脾阳虚同见，治疗当以益气温阳、补肝建脾为原则，用参、芪、附子、白术、茯苓、细辛、白芍、枣仁、乌梅、木瓜之类。对此类病人，如执持成说，反用疏肝泄肝，投以大量理气活血之品，必致戕伐太过，更虚其虚。兹举我用附子、白术合桂枝汤温振肝脾阳气治疗早期肝硬化的案例如下：
王某，女，49岁。
1974年11月5日初诊：患者罹早期肝硬化，近年来肝区胀痛，神倦纳呆，面色灰黄，月经二月未转，畏寒肢冷，盗汗，脉沉细无力，苔白滑。肝气虚，脾阳弱，气血不足。拟温阳而补气血，俟观动静：
熟附子、炒白芍各9克，鸡屎藤15克，白术9克，炙甘草、青陈皮各4.5克，桂枝6克，当归12克。
二诊：肝区胀痛得减，畏寒肢冷依然，经停已转，寐则多汗，面色萎黄，神疲纳增，脉细、苔白润。方药合度，仍守前法，以冀进步。
服上方后，症情又见好转，再守方参入枣仁、牡蛎、党参、川芎等药，连服二月，肝区胀痛得除，形寒肢冷转温，面有华色，艰寐盗汗亦瘥。蛋白电泳的γ球蛋白从12.5％上升至15.5％，血沉降率从35～65毫米／小时下降至正常范围，并恢复工作。随访年余，证情稳定，未见反复。
又如急性心肌梗塞，很多学者认为属中医「真心痛」的范畴。据临床体验，对照《金匮》及有关医著的记载，我认为本病不仅属于「真心痛」，还应属于「胸痹」范畴。大致可作如下划分：右胸疼痛剧烈，或者手足青至节，并在二十四小时内死亡的，为「真心痛」，痛虽剧烈，但不迅速死亡的为「胸痹」。《金匮》论「胸痹」曰：「阳微阴弦」，乃指心胸阳虚，阴寒痰饮乘于阳位所致，故治疗也局限于补阳益气、通阳散结、豁痰化饮之剂。近十多年来，据我临床所见，《金匮》所论与实际不尽相符。就本病病机而言，本虚标实确是心肌梗塞的特点所在。但本虚非徒阳虚，尚可见气虚、阴虚、阴阳两虚，甚或阳微阴竭，心阳外越等；标实也非仅痰饮为患，尚有气滞、血瘀致害，又有兼寒兼热之不同。同时，标本之间多相互影响，未可执一而言。因此，在治疗上也不能拘泥于《金匮》，应随证遣方，灵活掌握。我根据本病发生发展的规律，总结了三个治疗要点：一是处理好「补」和「通」的关系，掌握好「祛实通脉不伤正，扶正补虚不碍邪」的原则；二是防脱防厥，要细致观察患者在神、气息、汗、疼痛、四末及素体温度、舌苔、脉象等方面的变化，随时警惕厥脱的发生，用药也宜于厥脱之先，三是关于通便问题。本病患者常见便秘一证，由大便不畅引起心跳骤停而死亡者并不少见，故及时而恰当地通便，为治疗心肌梗塞的重要方法。立法用药时应分清阳结阴结，采取「先通使得去实，然后扶正补虚」或「补虚为主，辅以通便」等法，以助正气的恢复(详见《上海中医杂志》一九八一年第十期)。
类似上述的例子，在临床中比比皆是，不胜枚举。我觉得，面对临床实际，敢于提出新说，以发展祖国医学，这是我们义不容辞的责任。
在我年轻的时候，曾读《千金要方》，难解其意，视为「偏书」。解放初期我曾见方行维老先生治病用药甚为夹杂，每每认为是无师传授的结果。近二十余年来，我所遇疑难杂症，与日俱增，投以平时熟用之法，取效者不多，常百思不解。在这种情况下，遂再次攻读《千金要方》。随着阅历的加深，读起来就别有一番感受。我感到该书医学理论纵然不多，而方症记录朴实可信，其表里、寒热、补泻，升降、通涩等药常融冶在一方之中，可谓用心良苦，奥理蕴在其中。所谓疑难杂症者，大多症情错杂，非一法一方所能应对，当须详细辨证，切中病机所在，方能奏效，而不能被某些狭隘的理论所束缚，更不能受流派所承的学验所限制，必须扩展视野，进一步研究《千金》组方之杂，观察其临床之验，我想这是探索治疗疑难杂症的重要途径之一。例如：
1975年11月15日初诊：素有痰饮，近加外感，咳嗽气急口渴，自觉内热，高年心气不足，四末欠温，水湿滞留于下，二足浮肿，脉小数促，苔薄白腻。正虚邪实，寒热夹杂。拟标本兼治，益心肾而清化痰热：净麻黄4.5克，杏仁9克，生石膏24克，泽泻18克，炙甘草3克，党参、熟附片各9克，开金锁(另蒸冲服)、鱼腥草各30克，防己12克。
二诊：咳嗽减轻，气急渐平，咯痰亦少，胸闷不痛，心悸且慌，四肢渐温，脉细数促不匀，舌质暗。
太阴痰热日见清化，心肾亏损亦得好转，再拟养心活血佐以化湿肃肺：
熟附片15克，党参12克，炙甘草6克，泽泻、当归各15克，麦冬9克，炒川连2.4克，丹参15克，红花6克，防己12克。
本例素体肺气虚，痰饮内停，久而及于心肾，复又感受外邪，引动宿疾，遂致咳喘脉促，饮溢经络。患者又有口渴、内热、四肢欠温等症，寒热错杂之象，必探其本而标本兼治之。未可一味治标，故以麻杏石甘汤合参附汤，寒热并用，扶正祛邪，仅服七剂，证情大减，继以温阳养心肃肺活血之剂而收功。此乃宗《千金方》寒热补泻相兼组方之意，结合具体病症加以运用，从而使本例重病得到缓解，如：
1973年2月28日初诊：患者于解放战争时期有脑震荡史。从一九六0年起常有嗜睡或不眠之象，证情逐年加重。近四、五年来，嗜睡与不眠交替而作，眠则三、四十天日夜不醒，饮食须由家属呼而喂之，边食边睡，二便亦须有人照顾，有时则自遗；醒则十数天日夜不眠，烦躁喜动，头晕且胀。平时腰酸怕冷，手足逆冷，面色晦暗。得病之后，曾赴各地迭治不效，遂来沪诊治。刻下，神倦呆钝，边诊边睡，家属诉纳食尚可，口干，便艰解燥屎，苔白腻，舌边紫暗，脉沉细濡。多年顽疾，寒热虚实错综复杂，恐难骤效。书云「怪病属痰」。痰浊蒙蔽心窍，神志被困。姑先拟清心涤痰镇静宁神法，以观动静；
In 1924, I returned to my hometown to practice medicine. At that time, the farmers in the countryside lived in extreme poverty and suffered from diseases due to chronic overwork. Therefore, most illnesses were critical, especially severe heat diseases, such as cholera with vomiting and diarrhea, high fever leading to convulsions and coma, etc. The condition was dangerous, complex, and changed rapidly. Facing these difficult cases, based on my study of Ye Tianshi's *Wen Re Lun* (Treatise on Warm-Heat Diseases) and Wu Jutong's *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases), I diligently read medical texts such as Lei Shaoyi's *Shi Bing Lun* (Treatise on Seasonal Diseases), Wu Youke's *Wen Yi Lun* (Treatise on Pestilential Diseases), and Dai Tianzhang's *Guang Wen Yi Lun* (Expanded Treatise on Pestilential Diseases). I mastered the differences in treating general warm diseases and seasonal epidemic toxins. I realized that using only light and clear formulas like Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction) or Yin Qiao San (Honeysuckle and Forsythia Powder) often yielded no obvious effect, whereas prescribing formulas targeting turbid pestilential qi improved efficacy. However, I deeply felt that although various books on warm diseases elaborated much on preserving fluids and opening orifices, they were insufficient in differentiating and treating jue-ni (cold extremities and collapse). For instance, during the cholera epidemic at that time, many died. Symptoms included sudden violent vomiting and diarrhea, cold extremities, sweating, extreme thirst with desire to drink, but vomiting immediately after drinking. Most physicians treated according to warm disease methods, using sweet-cold or bitter-cold heat-clearing agents, with few survivors. In contrast, following Zhang Zhongjing's discussions, I used Bai Tong Jia Zhu Dan Jiang Tang (Bai Tong Decoction with Pig Bile), achieving considerable success. This inspired me to further study the *Shang Han Lun* (Treatise on Cold Damage) to supplement the deficiencies of warm disease theory, and to draw upon *Shang Han Zhi Zhang* to explore integrating Six Channels differentiation and Wei-Qi-Ying-Xue (Defensive, Nutritive, Ying, Blood) differentiation for rescuing critical heat diseases. Ancients said that one must view Shang Han and Wen Bing both vertically and horizontally; I found this profound. Interwoven, they are essentially one. Undeniably, regarding their formulas and drugs, each has its focus and expertise; only by mastering them comprehensively can one navigate clinical practice adeptly.
For example: Patient Fang XX, male, 25 years old, a consultation case at a certain hospital. The patient had pre-existing nephrotic syndrome and was admitted to the internal medicine ward of a certain hospital, receiving Western medicine Celestone (betamethasone). After the 17th treatment, his white blood cell count suddenly dropped to 200/mm³, accompanied by high fever (40.5°C). Blood cultures twice grew Staphylococcus aureus. Western medicine diagnosed sepsemia and secondary aplastic anemia. Celestone was stopped immediately, and multiple antibiotics were administered via intravenous drip and intramuscular injection for five days, but the high fever persisted, and the condition remained critical. On October 25, 1980, I was invited to consult. Signs included persistent high fever for six days, thirst at night, constipation, erythema (petechiae) on both lower limbs, yellow and greasy coating thick with cracks in the center and dryness, and a deficiency-thin-rapid pulse. I analyzed that the disease resulted from a major deficiency of righteous Qi, allowing pathogenic factors to enter through the deficiency. Pathogenic heat was hyperactive, blazing in the Qi level, scorching Yin fluids, and showing signs of entering the Ying level. Treatment should support righteous Qi, clear and transform pathogenic heat, using Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction), combined with cooling-blood rescue measures. The formula consisted of Sheng Shai Shen (Raw Sun-dried Ginseng) and Tie Pi Shi Hu (Dendrobium Officinale) to tonify Qi and preserve fluids; Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Jin Yin Hua (Lonicerae Japonicae Flos), and Lian Qiao (Forsythiae Fructus) to clear heat and vent it out; Chi Shao (Paeoniae Radix Rubra), Mu Dan Pi (Moutan Cortex), Han Lian Cao (Ecliptae Herba), and Ze Lan (Lycopersici Herba) for their intent to cool blood and dissipate stasis, preventing transmission. The entire formula employed three methods simultaneously: "clearing," "venting," and "nourishing." After two doses, the high fever subsided, and the white blood cell count rose to 4900/mm³. Ward physicians considered this formula an excellent heat-clearing agent and instructed the patient to continue taking the original formula for three more doses. Upon re-consultation on October 30, the patient exhibited lethargy, reluctance to speak, sallow complexion, profuse sweating, throat pain with thirst, root-greasy coating, pale-red tongue with central crack, thin-rapid pulse, and weak upon heavy pressure. I considered this caused by pathogens damaging Qi and Yin, compounded by excessive use of cold-cooling agents, leading to Yang damage and signs of deficient Yang floating outward. Although pathogenic heat had partially resolved, there was a risk of internal transmission to the Shao Yin channel. Thus, treatment focused on supporting righteous Qi and assisting in clearing residual pathogens. The formula heavily used Ji Lin Bai Shen (Jilin White Ginseng), Huang Qi (Astragali Radix), and Dang Gui (Angelicae Sinensis Radix) to tonify Qi and Blood and expel pathogens; Mu Li (Ostreae Concha) and Bai Shao (Paeoniae Radix Alba) to harmonize Ying and Wei and arrest sweating; Chai Hu (Bupleuri Radix), Jin Yin Hua, and Lian Qiao to vent residual pathogens; and Mai Dong (Ophiopogonis Radix) to clear heat and nourish Yin. After four doses, the heat disease resolved. Two weeks later, follow-up showed no bacterial growth in two blood cultures.
In this case, I first followed warm disease principles, then Shang Han principles, without rigid adherence to any single school, striving to legislate prescriptions with foresight, preventing changes before they occurred, thereby gaining initiative.
Mastering Medical Principles Requires Adaptability
After I began practicing in the suburban areas of rural cities, internal and gynecological miscellaneous diseases gradually increased in my clinic. Occasionally encountering officials and wealthy merchants, I had to be cautious in diagnosis and prescription. Outside of clinical duties, I deeply studied medical treatises by masters such as Dong Yuan, Dan Xi, and Jing Yue, as well as *Ming Yi Lei An* (Classified Cases of Famous Physicians), *Liu Xuan Si Jia Yi An* (Selected Cases of Four Masters by Liu), and *Lin Zheng Zhi Nan Yi An* (Clinical Guide to Medical Cases). I also kept *Lei Zheng Zhi Cai* (Compendium of Syndrome Differentiation and Treatment) on my desk for frequent reference. After moving to Shanghai, I often had opportunities to exchange ideas with old classmates Cheng Menxue and Qin Bowei. Through over twenty years of combining study and experience, my vision broadened, and my understanding deepened. In 1956, I joined Shuguang Hospital, where I encountered a wider range of diseases and took on teaching responsibilities for internal medicine clinical practice in higher traditional Chinese medicine education. This forced me to systematize and organize my TCM theoretical knowledge. However, I always felt my experience was limited, and clinical diseases were ever-changing, making it impossible to cure everything. Recalling the ancient warning, "There is no disease that cannot be cured, only doctors who cannot cure," I realized the key lies in physicians thoroughly studying classics, understanding various schools, adhering to norms while adapting to changes, and applying this clinically. This is the essence of the medical Dao.
For example: Patient Fan XX, female, 46 years old, first seen on September 21, 1974. The patient fell into a coma due to traumatic brain injury from a car accident. After 24 days of treatment at a certain hospital, consciousness remained impaired. There were unconscious movements in the right hand, while the left hand and both lower limbs could not move. Pulse was wiry-rapid, tongue coating was dry. Brain injury led to blood stasis blocking collaterals. The plan was to awaken the brain, invigorate blood, and unblock collaterals, prescribing Tong Qiao Huo Xue Tang (Open the Orifices and Invigorate Blood Decoction) with added Shi Pu (Acori Tatarinowii Rhizoma) and Yu Jin (Curcumae Radix), along with Zhi Bao Dan (Precious Pearl Pill).
Second visit: Consciousness fluctuated between clear and obscure. Headache, irritability, and screaming day and night persisted. Constipation and abdominal pain were present. Tongue coating turned pale-yellow and greasy; pulse was wiry-small-rapid. Sudden trauma caused stasis-heat coagulation and blockage, resembling the "mania-like" symptom of blood accumulation in the *Shang Han Lun*, distinct from mania caused by Yang Ming excess heat. The plan was Di Dang Tang (Di Dang Decoction) modified to resolve stasis and clear the mind. Formula: Shui Zhi (Hirudo) 9g, Meng Chong (Tabanus) 9g, Tao Ren (Persicae Semen) 12g, Dang Gui 18g, Shan Zhi Zi (Gardeniae Fructus) 15g, Hong Hua (Carthami Flos) 9g, Sheng Chuan Jun (Rhei Radix et Rhizoma) 6g (added later), Xian Shi Chang Pu (Fresh Acori Tatarinowii Rhizoma) 16g, Yu Jin 9g, Fu Ling (Poria) 9g.
Third visit: After administering heavy doses of modified Di Dang Tang, by the fourth dose, the left hand and both lower limbs could move. After another seven doses, followed by ten more doses, irritability and screaming significantly decreased, consciousness gradually cleared, but speech remained impaired. Yesterday, stools were soft three times, abdominal pain ceased. Tongue coating was yellow-greasy, pulse wiry-small. Collateral blood stasis was gradually resolving, but phlegm-damp-heat still obstructed the Middle Jiao. The next plan was to invigorate blood, harmonize the middle, and transform damp-heat. Huang Lian Wen Dan Tang (Coptis Warming the Gallbladder Decoction) combined with Tong Qiao Huo Xue Tang (removing She Xiang/Musk), plus Shi Pu and Kou Ren (Amomi Fructus Rotundus).
Subsequently, irritability and screaming ceased, consciousness gradually cleared, though hallucinations occasionally occurred. Based on symptoms, treatment involved invigorating blood, clearing the mind, harmonizing the middle, soothing the stomach, regulating Qi and Yin, assisted by clearing-transforming agents. Symptoms resolved, and the disease healed. Total treatment duration was over fifty days.
"Blood Accumulation" in the Bladder mentioned in the *Shang Han Lun* refers to Tai Yang Fu syndrome, where stasis-heat resides internally, manifesting as "mania-like" symptoms. Although the lesion site differs from this case's mania, the pathogenesis is similar: both result from stasis-heat disturbing the Spirit. Furthermore, Di Dang Tang uses Shui Zhi and Meng Chong, fierce agents to break stasis and purge blood, combined with Tao Ren and Da Huang to break blood, sweep heat, and guide stasis downward. This aligns well with the treatment principle for this disease, so I expanded its application and achieved satisfactory results.
Similarly, Gui Zhi Tang (Cinnamon Twig Decoction) in the *Shang Han Lun* is not limited to Tai Yang Wind Strike syndrome. According to its composition, it should have effects of harmonizing Ying, warming meridians, stimulating Spleen and Stomach, and relieving urgency/pain. Therefore, I widely applied it to deficiency-cold conditions such as chronic diarrhea, chronic pancreatitis, stomach pain, Xu Lao (deficiency consumption), and neural衰弱 (neurasthenia), with excellent results. This demonstrates the adaptability of Gui Zhi Tang in clinical practice.
From the above, we know that studying originals like the *Shang Han Lun* and *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) requires attention to detailed differentiation and precise medication, extracting their essence, and flexibly applying them clinically based on the spirit of "seeing even one symptom is sufficient... knowing the deviation, treat according to the syndrome." The same applies to other medical texts.
Not Bound by Established Doctrines, Expressing Personal Views
I often tell students: "Proficiency in medicine begins with mastering medical principles. However, to seek development, one must not blindly follow traditions or be bound by established doctrines, afraid to step beyond conventional limits. One must combine clinical practice, observe deeply, think diligently, summarize effectively, gain true knowledge, and express personal views." For nearly thirty years, I have held myself to this standard to achieve academic progress.
Regarding the understanding of Liver Yin and Yang, ancients stated that the Liver's substance is Yin, but its function is Yang. Liver Yin and Blood can be deficient, but Liver Qi and Yang functions are generally considered excessive. During decades of clinical practice, I often pondered: All five Zang organs have Yin and Yang and can exhibit Yin or Yang deficiency. Why is it said that Liver Qi and Yang never suffer deficiency? This view is one-sided. Although physicians like Wu Cheng and Tang Rongchuan mentioned Liver Qi deficiency and Liver Yang deficiency, they lacked elaboration and failed to apply it clinically. In reality, Liver Qi and Yang deficiency are common in clinical practice, especially in hepatitis and liver cirrhosis cases. Symptoms include dull or distending pain in the hypochondrium, worsening with fatigue, mental fatigue, weakness, abdominal distension, poor appetite, sallow/dull complexion, depression, aversion to cold, cold extremities, pale-swollen tongue, white or greasy coating, deficiency-thin-wiry or deep-weak pulse, often accompanying Spleen Qi weakness and Spleen Yang deficiency. Treatment should prioritize tonifying Qi and warming Yang, tonifying the Liver and strengthening the Spleen, using herbs like Ginseng, Astragalus, Prepared Aconite, Atractylodes Macrocephala, Poria, Asarum, White Peony, Ziziphus Seed, Mume Fruit, and Chaenomelis Fructus. For such patients, if one sticks to established doctrines and uses Liver-soothing/draining methods with large amounts of Qi-moving and blood-invigorating agents, it will cause excessive damage, further depleting deficiency. Here is a case of early liver cirrhosis treated by me using Prepared Aconite and Atractylodes combined with Gui Zhi Tang to warm and boost Liver-Spleen Yang:
Patient Wang XX, female, 49 years old.
First visit, November 5, 1974: Diagnosed with early liver cirrhosis. Recent years saw distending pain in the liver area, mental fatigue, poor appetite, sallow complexion, amenorrhea for two months, aversion to cold, cold extremities, night sweats, deep-weak pulse, white-slippery coating. Liver Qi deficiency, Spleen Yang weakness, Qi and Blood insufficiency. Plan: Warm Yang and tonify Qi and Blood, observe dynamics.
Formula: Prepared Aconite 9g, Stir-fried White Peony 9g, Cissus Quadrangularis Stem 15g, Atractylodes Macrocephala 9g, Honey-fried Licorice 4.5g, Green and Tangerine Peel 4.5g each, Cinnamon Twig 6g, Angelica Sinensis 12g.
Second visit: Liver area distending pain reduced, aversion to cold and cold extremities persist, menstruation resumed, night sweats during sleep, sallow complexion, mental fatigue, increased appetite, thin pulse, white-moist coating. Formula matches syndrome, maintain previous method to hope for progress.
Modify previous formula: Remove Green and Tangerine Peel, add Carthamus 6g, Calcined Turtle Shell 18g.
After taking the above formula, symptoms improved again. Maintain formula, adding Ziziphus Seed, Oyster Shell, Codonopsis, and Ligusticum Chuanxiong. Taken continuously for two months, liver area distending pain disappeared, cold extremities warmed, complexion became lustrous, insomnia and night sweats also improved. Gamma globulin in protein electrophoresis rose from 12.5% to 15.5%, erythrocyte sedimentation rate dropped from 35-65 mm/h to normal range, and work capacity recovered. Follow-up for over a year showed stable condition with no recurrence.
Similarly, acute myocardial infarction is considered by many scholars to belong to the category of "Zhen Xin Tong" (True Heart Pain) in TCM. Based on clinical experience and comparing records in *Jin Gui* and related medical texts, I believe this disease belongs not only to "Zhen Xin Tong" but also to "Xiong Bi" (Chest Bi/Obstruction). Rough classification: Severe right chest pain, or blue extremities up to joints, death within 24 hours, is "Zhen Xin Tong"; severe pain but not rapidly fatal is "Xiong Bi". *Jin Gui* discusses "Xiong Bi" as "Yang微弱 Yin String-taut," referring to Heart-Chest Yang deficiency, where Yin-cold-phlegm-fluids invade Yang positions. Thus, treatment is limited to tonifying Yang, boosting Qi, unblocking Yang, dissipating nodules, and resolving phlegm-fluids. Over the past decade+, my clinical observations show discrepancies between *Jin Gui* descriptions and reality. Regarding pathogenesis, deficiency-root and excess-branch are characteristics of myocardial infarction. However, deficiency-root is not merely Yang deficiency; it can involve Qi deficiency, Yin deficiency, dual deficiency, or even Yang微弱 Yin exhaustion, Heart Yang floating outward. Excess-branch is not just phlegm-fluids; it includes Qi stagnation and blood stasis, with variations of cold or heat accompaniment. Root and branch often influence each other; one cannot generalize. Therefore, treatment cannot be confined to *Jin Gui*; prescriptions must be flexible based on symptoms. Summarizing three key points based on the disease's development: First, handle the relationship between "tonifying" and "unblocking," mastering the principle of "removing excess to unblock vessels without harming righteousness, supporting righteousness and tonifying deficiency without hindering pathogens." Second, prevent collapse and jue-ni; carefully observe changes in spirit, breathing, sweat, pain, extremities, baseline temperature, tongue coating, and pulse, vigilantly guarding against collapse, and medicating preemptively. Third, addressing constipation. Constipation is common; death from cardiac arrest due to bowel obstruction is not rare. Timely and appropriate bowel evacuation is crucial. When legislating prescriptions, distinguish between Yang-constraint and Yin-constraint, adopting methods like "first evacuate to remove excess, then tonify righteousness" or "primarily tonify deficiency, assist with bowel evacuation" to aid righteous Qi recovery (see *Shanghai Journal of Traditional Chinese Medicine*, Oct 1981).
Examples like the above are ubiquitous in clinical practice. I feel that facing clinical reality, daring to propose new theories to develop national medicine is our indispensable responsibility.
Treating Miscellaneous Diseases Tracing Back to *Qian Jin*
When young, I read *Qian Jin Yao Fang* (Essential Prescriptions Worth a Thousand Gold) but found it hard to understand, viewing it as a "partial book." In the early liberation period, I saw Mr. Fang Xingwei use mixed medications, often attributing it to lack of formal teaching. For over twenty years, difficult and miscellaneous cases increased daily. Methods I usually used yielded few results, causing confusion. Under these circumstances, I reread *Qian Jin Yao Fang*. With deeper experience, I gained new insights. Although the book lacks extensive medical theory, its case records are simple and credible. It often combines exterior-interior, cold-heat, tonifying-draining, ascending-descending, and unblocking-astringent herbs in one formula, showing meticulous care and profound principles. Difficult miscellaneous cases usually present complex symptoms that cannot be addressed by a single method or formula. Detailed differentiation targeting the core pathogenesis is required, avoiding narrow theories or sectarian limitations. One must broaden horizons and further study the complexity of *Qian Jin*'s formulations and their clinical efficacy. I believe this is an important path to exploring treatments for difficult cases.
For example: Patient Yao XX, female, 75 years old.
First visit, November 15, 1975: History of Phlegm-Fluid retention, recently complicated by external contraction. Cough, shortness of breath, thirst, sensation of internal heat. Elderly age implies Heart Qi deficiency, cold extremities. Water-dampness stagnating below causes bilateral foot edema. Pulse is small-rapid-hurried, coating thin-white-greasy. Righteous deficiency and pathogenic excess, mixed cold and heat. Plan: Treat root and branch simultaneously, benefit Heart-Kidney, clear-transform Phlegm-Heat.
Formula: Clean Ephedra 4.5g, Apricot Kernel 9g, Raw Gypsum 24g, Alisma 18g, Honey-fried Licorice 3g, Codonopsis 9g, Prepared Aconite Slice 9g, Kai Jin Suo (Passiflorae Caulis) steamed separately and taken with decoction 30g, Houttuynia 30g, Stephania Tetrandra 12g.
Second visit: Cough reduced, shortness of breath leveled, less sputum, chest fullness without pain, palpitations and panic, extremities gradually warm. Pulse fine-rapid-hurried irregular, tongue body dark.
Tai Yin Phlegm-Heat is being cleared daily, Heart-Kidney deficiency improving. Next plan: Nourish Heart, invigorate blood, assist with transforming dampness and purging Lung.
Formula: Prepared Aconite Slice 15g, Codonopsis 12g, Honey-fried Licorice 6g, Alisma 15g, Angelica Sinensis 15g, Ophiopogon 9g, Stir-fried Coptis 2.4g, Salvia 15g, Carthamus 6g, Stephania Tetrandra 12g.
This patient had constitutive Lung Qi deficiency and internal Phlegm-Fluid retention, which eventually affected Heart-Kidney. External pathogens triggered latent illness, causing cough, wheezing, hurried pulse, and fluid overflowing into collaterals. Symptoms included thirst, internal heat, cold extremities—mixed cold-heat signs. Must probe the root and treat root and branch. Cannot solely treat symptoms. Thus, Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) combined with Shen Fu Tang (Ginseng and Aconite Decoction) used cold and heat together, supporting righteousness and expelling pathogens. Only seven doses greatly reduced symptoms. Continued with warming Yang, nourishing Heart, purging Lung, and invigorating blood agents to conclude treatment. This follows the *Qian Jin Fang* principle of combining cold-heat and tonifying-draining in formulations, adapted to specific conditions, alleviating the severe illness.
Another example: Patient Shi XX, male, 52 years old.
First visit, February 28, 1973: History of concussion during the Liberation War. Since 1960, experienced hypersomnia or insomnia, worsening yearly. For the past 4-5 years, hypersomnia and insomnia alternated. Sleep periods lasted 30-40 days continuously, requiring family to wake and feed him, eating while sleeping. Bowel/bladder control needed assistance, sometimes involuntary loss. Awake periods lasted over ten days continuously, with irritability, restlessness, dizziness, and head distension. Usually sore back, aversion to cold, cold extremities, dull complexion. After ineffective treatments elsewhere, came to Shanghai. Currently, mental fatigue, dullness, sleeping during consultation. Family reports adequate appetite, dry mouth, difficult passage of dry stool, white-greasy coating, purple-dark tongue edges, deep-thin-soggy pulse. Chronic stubborn disease, complex mixed cold-heat-deficiency-excess, unlikely to respond quickly. Books say "Strange diseases belong to Phlegm." Phlegm-turbidity obscures Heart Orifices, trapping Spirit. Tentatively prescribe Clear Heart, Wash Away Phlegm, Calm Spirit method to observe dynamics;